Browsing by Subject "Anxiety disorders"

Now showing 1 - 3 of 3

Externalizing behaviors in youth with anxiety : a replication and extension of previous findings
(2019-09-18) Mitchell, Abigail Grace; Stark, Kevin Douglas; Carlson, Cindy; Pustejovsky, James; Smits, Jasper
This study examined the nature of externalizing behaviors among 500+ youth ages 7-17 with a primary diagnosis of Generalized Anxiety Disorder (GAD), Separation Anxiety Disorder (SAD), and/or Social Phobia (SoP). It builds on previous findings suggesting that externalizing symptoms may be an under-recognized feature of childhood anxiety disorders (Garland & Garland, 2001; Mireault, Rooney, Kouwenhoven, & Hannan, 2008; Williams, Dahan, Silverman, & Pettit, 2013). As a first step, this study employed two exploratory techniques that sought to classify participants into subgroups based on their presentation of externalizing symptoms. Results of a two-step cluster analysis indicated a best-fitting 2-cluster model in which subgroups differed by average severity of aggressive behaviors. Results of the second classification approach, Latent Class Analysis (LCA), indicated a best-fitting 3-class model in which subgroups differed by overall severity of externalizing symptoms. These results were largely similar to a prior study that used the same approach to classify a similar sample of anxious youth (Williams et al., 2013). A comparison of subgroups within each analysis suggested that externalizing problems among anxious youth are related to anxiety severity, anxiety subtype, and to youth age; no relation was found with regard to youth gender. Furthermore, exploratory findings highlighted a handful of specific behaviors that are particularly likely to co-occur with childhood anxiety (e.g., arguing, disobedience, temper tantrums). These behaviors may reflect the youth’s attempt to avoid anxiety-induced distress. A second phase of analysis utilized post-treatment data to examine the relationship between externalizing behaviors and response to anxiety treatment. Contrary to the investigator’s hypothesis, results of regression analyses indicated that externalizing symptoms prior to treatment were not significantly related to child treatment response, suggesting that anxious youth with greater externalizing problems may benefit from treatment as much as those who do not present with these behavioral challenges. Taken together, these findings have implications for the identification, assessment, and treatment of youth anxiety disorders.
Investigating normal and pathological variation in memory-based inhibition : an examination of worry, thought suppression, and stimuli characteristics
(2009-08) Brown, Matthew Adam; Telch, Michael Joseph
This work was conducted in an effort to better understand the role that activational mechanisms in memory play in the etiology and maintenance of anxiety disorders. The affect of word stimuli characteristics, such as affective valence and semantic association with worry, on the association between inhibition and trait worry was investigated under different types of induced thought. Previous research has demonstrated that worry is associated with negative affect, and that worry may be semantically organized in memory. Based on these findings, it was hypothesized that words would be differentially inhibited in association with trait worry when worry was induced compared to neutral thought. Stimuli characteristics including the positive or negative affective valence of words, and their semantic association with common domains of worry were expected to moderate the relationship between inhibition and trait worry. In order to investigate these hypotheses, 86 undergraduate students from the University of Texas at Austin completed a series of memory tasks designed to measure inhibition for either negative or positive words, both associated and unassociated with worry. They underwent either idiopathic worry or neutral thought induction prior to completing each memory task, and completed questionnaires assessing trait worry and thought suppression. The findings provide partial support for the hypotheses. Higher levels of trait worry were associated with less inhibition of negative words, but more inhibition of positive words semantically associated with worry. Contrary to predictions, differential induction of worry did not affect the relationship between inhibition and trait worry. The research and clinical implications of these findings are discussed.
tDCS-augmented exposure therapy for pathological fears
(2019-08) Cobb, Adam Roark; Telch, Michael Joseph; González-Lima, Francisco, 1955-; Schnyer, David M; Smits, Jasper A; Bikson, Marom
Exposure therapy is remarkably effective for treating anxiety and stress-related problems. Still, there is a need to enhance the efficacy, efficiency, and palatability of exposure. Recent efforts have sought to optimize extinction learning, through procedural variations, or by targeting underlying cellular mechanisms. Guided by evidence that brain stimulation can functionally target brain networks implicated in fear expression and extinction learning, the present study is a 2-arm, double-blind, placebo-controlled trial testing whether transcranial direct current stimulation (tDCS) can augment exposure therapy for several forms of pathological fear. Participants (N = 49) with at least moderate distress in response to snakes, spiders, or contamination-related threats were randomized to receive either active tDCS (1.7 mA, 20 min.; n = 27), or sham tDCS (1.7mA, 30 sec.; n = 22), followed by 30 min. of in-vivo exposure. Electrodes targeted excitation of the left medial prefrontal cortex (lmPFC) and inhibition of the right dorsolateral prefrontal cortex (rdlPFC) for those assigned to active tDCS, whereas polarity was counterbalanced across controls. The active tDCS group exhibited greater gains compared to sham tDCS in primary and secondary outcomes, including reductions in distress and threat appraisals through the 1-month follow-up, although these findings did not uniformly generalize to an untrained context. The active tDCS group also exhibited more rapid cognitive change during exposure, and enhanced approach in early exposure trials. Active tDCS also especially enhanced outcomes for those with greater phobic severity, a poorer response to exposure, elevated anxiety sensitivity, and an avoidant coping style. Exploratory analyses revealed tDCS-augmentation effects were partially accounted for by increased attentional and behavioral engagement with threat. Future research should apply tDCS to more severe conditions, and yoke stimulation to individual differences to maximize and promote the retention of clinical gains